scholarly journals End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis

2019 ◽  
Vol 34 (1) ◽  
pp. 49-68 ◽  
Author(s):  
Rebecca Wilson ◽  
Nilay Hepgul ◽  
Irene J Higginson ◽  
Wei Gao
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Mental Illness ◽  
General Population ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Place Of Death ◽  
Narrative Synthesis ◽  
Life Care

Background: People with serious mental illness have greater mortality risk than the general population. They experience health care inequalities throughout life; it is not clear if this persists to end of life. Aim: Assess the empirical evidence describing end-of-life care and place of death for people with serious mental illness. Design: A systematic review of original, peer-reviewed research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analysed using a narrative synthesis approach. Data sources: Five online databases (Embase, PsycArticles, PsycINFO, Medline, PubMed) and additional sources were searched (without time restriction) for primary research reporting health care utilisation in the last year of life or place of death in adults with serious mental illness. Results: After full-text screening, 23 studies were included. We found studies reporting hospital admissions, emergency department care, palliative care, and general practitioner (GP) visits at end of life. We found conflicting evidence for the association between serious mental illness and end-of-life care, although different patient groups, settings and measures were used across studies. People with serious mental illness were more likely to die in care homes than the general population. There were no patterns for other places of death. Conclusions: The evidence was sparse and heterogeneous, demonstrating variability in patterns and reporting of health care use and with little consensus on where people with serious mental illness are likely to die. Given that people with serious mental illness have increased mortality risk, this gap in the knowledge around end-of-life care outcomes is concerning; this area of research needs further development.

Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

2021 ◽  
pp. 104990912110107
Author(s):  
Kate L. M. Hinrichs ◽  
Cindy B. Woolverton ◽  
Jordana L. Meyerson
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Psychosocial Support ◽  
Life Care ◽  
Case Examples ◽  
Increased Risk ◽  
Palliative Care Teams

Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses—Bipolar Disorders, Major Depressive Disorder, and Schizophrenia—are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.

scholarly journals End-of-Life Care in Individuals With Serious Mental Illness

2020 ◽  
Vol 61 (5) ◽  
pp. 428-435
Author(s):  
Daniel Shalev ◽  
Lauren Fields ◽  
Peter A. Shapiro
Keyword(s):  
Mental Illness ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Life Care

scholarly journals 458 - End-of-life decision-making capacity in an elderly patient with schizophrenia and terminal cancer

2020 ◽  
Vol 32 (S1) ◽  
pp. 179-179
Author(s):  
C Kotzé ◽  
JL Roos
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Decision Making Capacity ◽  
Advance Care ◽  
End Of Life Decision

Medical practitioners are confronted on a daily basis with decisions about patients’ capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end -of-life decision-making capacity in a 72-year old lady with treatment resistant schizophrenia and terminal cancer will be discussed.In the case discussed there were differences in opinion about the patients decision-making capacity. In light of this, the role of the treating clinician and importance of health-related values in capacity assessment are highlighted. It is recommended that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient’s wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient’s capacity will change the treatment approach.Compared to the general population, people with serious mental illness have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services and are rarely engaged in end-of-life care discussions. Older people with serious mental illness can engage in advance care planning. Conversations about end -of-life care can occur without fear that a person’s psychiatric symptoms or related vulnerabilities will undermine the process. Clinicians are also advised to attend to any possible underlying issues, instead of focusing strictly on capacity. Routine documentation of end-of-life care preferences can support future decision making for family and clinicians at a time when patients are unable to express their decisions.More research about palliative care and advance care planning for people with serious mental illness is needed. This is even more urgent in light of the COVID-2019 pandemic, as there are potential needs for rationing of health care in the context of scarce resources. Health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with serious mental illness.

scholarly journals Preference for Initiation of End-of-Life Care Discussion: a quantitative study

2020 ◽  
Author(s):  
Venita Eng ◽  
Victoria Hewitt ◽  
Aria Kekalih
Keyword(s):  
Health Care ◽  
General Population ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Healthcare Providers ◽  
Vital Role ◽  
Life Care ◽  
Cross Sectional

Abstract Background: Initiating discussion about end of life is often considered a difficult topic for healthcare providers, thus there is a need for further research to understand this area, particularly in developing countries. This study seeks to describe preferences for the initiation of end-of-life care conversations in Indonesia, comparing the general population and health care professionals.Methods: This study was a cross-sectional descriptive study to gain quantitative data utilizing a questionnaire distributed online. There was a total of 368 respondents (254 general population (69%); 114 healthcare professionals (31%)) with a consecutive sampling method. Result: Overall, most respondents (80.4%) would like to discuss the end of life issues with a healthcare professional in case of terminal illness. This was more marked amongst health care professionals compared with the general population (94% vs. 75%, respectively, p < 0,001). The preferred time for discussion was at first diagnosis (63%) or the request of the patients (27%), and the preferred person to start the discussion was the doctor (64%). Depth of information varies as fewer respondents would want to know about prognosis than diagnosis (76% v 93%).Conclusion: Doctors have vital role in end-of-life care discussion, and attempts should be made to encourage physicians to initiate end-of-life care discussion when needed. Further qualitative study in this topic would help to create a practical guideline to aid physicians in end-of-life care discussion.

48 Junior doctors and end of life care: a systematic review and narrative synthesis

2018 ◽  
Vol 8 (3) ◽  
pp. 378.1-378
Author(s):  
Aamena Bharmal ◽  
Tessa Morgan ◽  
Stephen Barclay
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Empirical Literature ◽  
Junior Doctors ◽  
List Type ◽  
Narrative Synthesis ◽  
Life Care ◽  
Dying Patients

BackgroundNearly 50% of all deaths in the UK occur in hospitals.1 The majority of these patients die in a generalist setting2 where their medical care is predominately provided by junior doctors. There is a growing recognition of a need to embed palliative care into doctors’ training.3Little evidence exists, however, concerning junior doctors’ current experiences of palliative care.AimsTo review the empirical literature between 2000 and 2018 concerning junior doctors experience of and preparation for palliative and end of life care.MethodsSystematic review and narrative synthesis of qualitative and quantitative studies within six databases to find empirical studies on junior doctors experience of adult palliative care in inpatient hospital or hospice settings.ResultsFrom the initial 6308 titles identified, 32 studies met the inclusion criteria with a further five identified from reference searching.Three key themes were identified:‘Significance of death and dying’‘Thrown into the deep end’‘Addressing the gaps’. All the studies provided evidence that junior doctors care for many dying patients very early in their career. Junior doctors do not feel adequately prepared to care for dying patients and feel unsupported when doing so. Junior doctors report emotional distress when caring for their first few dying patients, memories of which continue to affect them throughout their careers. Their attitudes towards end–of–life care varied: some reported it as a privilege while others associated it with a culture of disengagement that stigmatised dying patients.ConclusionsJunior doctors need further support, education and preparation for their exposure to palliative care. Experiential learning, reflective practice and role modelling are described as the most effective ways to learn palliative care and this also teaches them other transferrable skills such as communication, teamwork and professionalism that are vital for their future careers.References. Office for National Statistics Deaths Registered in England and Wales2016.. Gomes B, Higginson I. Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Med2008;22:33–41.. General Medical Council. Tomorrow’s doctors: Recommendations on undergraduate medical education 2002 (2nd ed.). London: GMC.

scholarly journals Ethico-legal issues in relation to end-of-life care and institutional mental health

2006 ◽  
Vol 30 (3) ◽  
pp. 286 ◽  
Author(s):  
Pam D McGrath ◽  
Kim Forrester
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Palliative Care ◽  
End Of Life ◽  
Serious Mental Illness ◽  
End Of Life Care ◽  
Legal Issues ◽  
Life Care ◽  
Health Institution ◽  
Mental Health Institution

Objectives: In view of the fact that there is a higher mortality rate for individuals with serious mental illness and that people with mental illness suffer excess mortality due to physical illness, the lack of attention to end-of-life care for patients with a serious mental illness needs addressing. This article seeks to put these issues on the agenda by beginning to explore important ethico-legal issues at the interface of palliative care and institutional mental health. Methods: Data were collected from eight qualitative interviews conducted with mental health professionals at The Park, Centre for Mental Health, Queensland. The interviews were recorded verbatim, coded and thematically analysed. Results: The findings highlight the inherent tension at the interface of compassionate, patientcentred end-of-life care and the participants? perception of the legal restraints imposed by virtue of being in a mental health institution. This article examines the participants? perceptions of the legal restraints curtailing the provision of palliative care in a mental health institution and considers these findings within an understanding of the limitations imposed by law. Our hope and expectation in undertaking this exploration is to clarify the legal limitations that operate to restrict the type of end-of-life care that can be offered to mental health patients, in order to provide an informed basis for practice.

scholarly journals What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis

2019 ◽  
Vol 33 (4) ◽  
pp. 399-414 ◽  
Author(s):  
Daniel Stow ◽  
Gemma Spiers ◽  
Fiona E Matthews ◽  
Barbara Hanratty
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Narrative Synthesis ◽  
Life Care ◽  
Family Needs ◽  
Psychosocial Needs ◽  
Care Needs ◽  
Critical Phases

Background: The number of older people living and dying with frailty is rising, but our understanding of their end-of-life care needs is limited. Aim: To synthesise evidence on the end-of-life care needs of people with frailty. Design: Systematic review of literature and narrative synthesis. Protocol registered prospectively with PROSPERO (CRD42016049506). Data sources: Fourteen electronic databases (CINAHL, Cochrane, Embase, EThOS, Google, Medline, NDLTD, NHS Evidence, NICE, Open grey, Psychinfo, SCIE, SCOPUS and Web of Science) searched from inception to October 2017 and supplemented with bibliographic screening and reference chaining. Studies were included if they used an explicit definition or measure of frailty. Quality was assessed using the National Institute for Health tool for observational studies. Results: A total of 4,998 articles were retrieved. Twenty met the inclusion criteria, providing evidence from 92,448 individuals (18,698 with frailty) across seven countries. Thirteen different measures or definitions of frailty were used. People with frailty experience pain and emotional distress at levels similar to people with cancer and also report a range of physical and psychosocial needs, including weakness and anxiety. Functional support needs were high and were highest where people with frailty were cognitively impaired. Individuals with frailty often expressed a preference for reduced intervention, but these preferences were not always observed at critical phases of care. Conclusion: People with frailty have varied physical and psychosocial needs at the end of life that may benefit from palliative care. Frailty services should be tailored to patient and family needs and preferences at the end of life.

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